Name of MTFMedical Equipment Tracer Checklist

Process: Staff Knowledge/Medical Equipment Date: Location: Inspected by:

Check Gaps and RecommendationsPlan – Does the department use medical equipment?

– Are equipment manuals maintained in the department and accessible?

Teach – Is staff competency regarding equipment use documented?Implement Staff can answer the following questions:

– Do you help medical equipment repairers find equipment requiring preventive maintenance?– What equipment is maintained by the Medical Equipment Branch?– What equipment is maintained by contractor?– How do you know if the equipment is properly maintained?– How do you clean and disinfect this (name of device)?

Respond – Have you had any medical equipment fail in the past 12 months?– Was it necessary to initiate emergency clinical procedures when the (name of device) failed?– What did you do?– How did you report the failure?– How quickly did the Medical Equipment Branch/contractor respond when the (name of device) failed?– What was the reason that the equipment failed?– Is there back-up equipment for (name device)?– Where is the back-up equipment located?– What policies or SOPs are in place to address this type of failure?

Monitor – Has the equipment failed more than once?Improve – What actions were taken to prevent future failures?

Reviewed 20 March 2015